Basic Information
| Provider Information | |||||||||
| NPI: | 1003212556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE INC | ||||||||
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| OtherOrganizationName: | SAINT VINCENT MEDICAL GROUP OF CORRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 YORK ST | ||||||||
| Address2: | |||||||||
| City: | CORRY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 164071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146648686 | ||||||||
| FaxNumber: | 8146649826 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 YORK ST | ||||||||
| Address2: | |||||||||
| City: | CORRY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 164071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146648686 | ||||||||
| FaxNumber: | 8146649826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2014 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8144525016 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.